At-Risk Newborns Don't Need Blood Tests to Screen for Group B Strep

Blood Tests Cause Pain and Anxiety without Detecting Infections, Study Finds

Newswise — Philadelphia, Pa. (October 24, 2011) – For newborn infants at risk of infection with group B streptococcal (GBS) bacteria, screening blood tests cause extra pain and anxiety—without increasing detection of early-onset GBS disease, reports a study in the October issue of The Pediatric Infectious Disease Journal. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Repeated blood tests to screen at-risk newborns leads to "a negligible clinical yield and a high rate of technical failure," according to the report by Dr Saar Hashavya and colleagues of Hadassah and Hebrew University Medical Center, Jerusalem.

Results Question Need for Blood Tests and Cultures to Detect GBS after BirthGroup B strep causes potentially life-threatening infections in newborn infants. The infections are often transmitted at birth from mothers who are carriers of the GBS bacteria. (Being a "carrier" means that the bacteria are present, but aren't causing any disease in the mother.) Beginning in the 1990s, hospitals started giving preventive antibiotics during the last weeks of pregnancy to mothers carrying GBS.

However, sometimes there's not enough time to give the recommended course of treatment before the infant is delivered. In this situation, the infant may undergo blood tests (complete blood count) and blood cultures to detect GBS bacteria.

To evaluate this practice, Dr. Hashavya and coauthors reviewed their medical center's experience with 5,845 GBS-carrier mothers treated from 2005 through 2009. Twenty-eight percent of the mothers were "partially treated," receiving only one dose of antibiotics less than four hours before delivery.

After birth, blood tests and blood cultures were performed in 86 percent of infants born to partially treated mothers. In 18 percent of these infants, a second blood sample was needed because of some abnormal result or technical problems with the first sample.

None of the blood cultures performed within six hours after birth showed the presence of GBS. In a small number of cases (less than one percent), the cultures were contaminated with staph bacteria. These infants required intensive clinical observation and repeated blood cultures to confirm that they didn't have GBS infection.

Nearly All Cases of Early-Onset GBS Would Be Detected Without ScreeningOverall, early-onset GBS infection occurred in 11 out of nearly 54,000 infants. Only two of these infants had mothers who were GBS carriers; neither was identified by blood screening tests. Most of the infants with GBS infection developed symptoms immediately or within the first 12 hours after birth—again, blood tests were not needed to identify the infected patients.

With the introduction of preventive antibiotic treatment, the rate of early-onset GBS infections has greatly decreased. However, there's no clear approach to treatment for infants whose mothers don't receive the full recommended course of treatment before delivery. The new study strongly suggests that blood tests and cultures are not effective or necessary in detecting early-onset GBS in infants born to these partially treated mothers.

Pending further studies, the results support the recently revised recommendation for "expectant management"—observing the infant for any sign of illness for at least 48 hours—instead of blood tests. In infants without symptoms, early blood tests appear to be of little or no value in detecting GBS infection. "More importantly, [the study] shows the drawbacks in terms of unnecessary stress to the newborn and his or her family," Dr. Hashavya and coauthors conclude.

About The Pediatric Infectious Disease JournalThe Pediatric Infectious Disease Journal® (http://www.pidj.com) is a peer-reviewed, multidisciplinary journal directed to physicians and other health care professionals who manage infectious diseases of childhood. The journal delivers the latest insights on all aspects of infectious disease in children, from state-of-art diagnostic techniques to the most effective drug therapies and other essential treatment protocols. The Pediatric Infectious Disease Journal is official journal of the Pediatric Infectious Diseases Society and the European Society for Paediatric Infectious Diseases.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).